مجله جراحی استخوان و مفاصل ایران
سال نوزدهم شماره 1 (پیاپی 72، زمستان 1399)

Pediatric patients with Blount disease frequently demonstrate secondary adaptive deformities in the adjacent distal femur. This study evaluates adaptation of longitudinal and angular proportions of the ipsilateral healthy femur to progressive leg length discrepancy in unilateral cases.

  The study included 55 children with unilateral Blount disease. Preoperative radiographs were analyzed to characterize the condition as infantile or adolescent and measure femoral/tibial lengths and mechanical lateral distal femoral angles (mLDFA). 

There were 26 patients with infantile and 29 with adolescent Blount disease. Adolescent patients were significantly older (14.4 ± 2.0 vs. 9.2 ±2.4; p<0.01). Black race was prevalent in both groups (69-79%). The adolescent group was predominantly male (25/29; 86%), while the infantile group was predominantly female (15/26; 58%, p<0.01). Leg length inequality in adolescent patients was significantly greater than in the infantile group (2.8 ± 2.0 vs.1.5 ± 1.1cm; p<0.01) with ipsilateral femoral shortening (1.8 ± 1.8 cm) accentuating tibial shortening (1.0 ± 1.1cm). Patients with infantile Blount disease had more pronounced tibial discrepancy (2.0 ± 1.1 cm; p<0.01) but modest overgrowth of the ipsilateral femur (0.5 ± 0.7; p<0.01) partially compensating ipsilateral tibial shortening. There was a significant difference in tibial:femoral ratios between the groups (p<0.01). The infantile group had on average normal mLDFA (88°), most adolescent patients had accentuating distal femoral varus deformity (96° ± 5°; p<0.01).

Patients with unilateral infantile and adolescent Blount disease demonstrated distinctly different adaptation of the ipsilateral femur. Concomitant ipsilateral femoral changes aggravate angular deformity and leg length discrepancy in adolescent Blount disease.

The use of parathyroid hormone in the management of fracture disorders is poorly documented. Aim of study was evaluation of parathyroid hormone efficacy on :union: of tibia/fibula diaphysis fractures.

It was a hospital-based study who conducted on patient with non-:union: or delayed-:union: fracture of tibia/fibula. At Shahid Kamyab hospital, patients with inclusion criteria, entered the study after completing the conscious consent form in both case and control groups. CBC, ESR, Ca, P, Mg, ALK-P, Cr, BUN tests were performed as baseline, then in the case group prescribe oral D-Calcium and monthly injection of parathyroid hormone for 3 months at a daily dose of 8 units and in the control group, prescribe oral D-Calcium and the expected treatment method, and those who had a specific risk factor such as digoxin tablets or kidney failure were excluded from the study. After entering the study and receiving the hormone once the month, patients evaluate with radiographic parameter. 

Of evaluated cases, mean and standard deviation of age in the intervention group was 16.9 ± 37.7 years and in the control group was 13.8 ± 39.1 years (P = 0.73). In terms of gender in the two groups, 24 cases were male and 6 cases were female (P = 1.0). In addition in clinical findings, fracture type (P = 1.0), fracture shape (P = 0.18), fixation method (P = 0.26), radiographical result (P = 0.06) did not have a statistically significant difference between the two groups.

We not find any positive effect of this hormon on fracture status, as clinical or para clinical evaluation.

Deep vein thrombosis (DVT) is accompanied by adverse effects after surgery and the prevalence of this complication is unknown following knee replacement surgery in patients with a history of chemotherapy. Therefore, the present study aimed to investigate the frequency of DVT after knee replacement surgery in patients with a history of chemotherapy.

This descriptive-analytical study was performed on 189 candidates for knee replacement surgery who had a history of chemotherapy during 36 months ending in March 2016 and referred to Shohada and Imam Reza hospitals affiliated to Tabriz University of Medical Sciences, Tabriz, Iran. After surgery, patients were evaluated for the incidence of DVT and the factors, influecing it based on the instrument of determining DVT and Doppler ultrasound. Statistical analysis was completed by Spearman’s correlation and regression tests.

The mean standard deviation of DVT score was 43.49 ± 6.66, which indicates that after knee replacement surgery, patients with a history of chemotherapy are at high risk for DVT. The prevalence of DVT was 25.92% (N=49) and the number of chemotherapy sessions (P=0.001) correlated with the occurrence of DVT.

The prevalence of DVT following knee replacement surgery in people with a history of chemotherapy is above the normal mean reported in the literature. Consequently, further therapeutic and preventive measures are required.

In recent years, spinal fusion surgery has become one of the most common treatments for spinal cord injuries, while the interbody cages, which replace the damaged interbody discs in the surgeries, have undergone extensive changes in design and material. These changes are quite visible, ranging from plain titanium cages made using the conventional manufacturing methods to customized porous titanium cages, which are made using additive manufacturing technology, or titanium-coated polymer cages. Among all the materials used in manufacturing the interbody cages, PolyEther Ether Ketone (PEEK) and titanium are the most common ones. Each of these two has its own advantages and disadvantages. Several studies have compared these two materials, mostly based on the two characteristics of subsidence and fusion rates. The present study performed a comprehensive review of the published clinical studies comparing the titanium and PEEK cages in order to make a comprehensive evaluation of these two. According to the reviewed studies, both materials had relatively similar results in subsidence rate, with no significant difference. However, it was shown that the titanium cages had a better fusion rate and subsequently were more likely to be successful in the clinical settings than the PEEK cages.

Hip fracture is a significant health problem with a high morbidity and mortality, especially in patients aged 80 years and more. In this study, we aimed to identify demographic characteristics and management of octogenarian patients with hip fracture and also aimed to determine the predictors of perioperative complications.

Data for all patients aged 50 years old or more who were hospitalized for hip fracture between June 2015 and June 2020 were retrospectively analyzed. Data of patients aged 80 and older were compared with those younger than 80 from the same cohort.

A total of 601 patients (mean age 73.9 ± 9.4 years, 62.2% female) were included. Of the study population, 21 patients (3.5%) were treated conservatively, and 580 patients (%96.5) underwent surgery. Of the 580 patients who had surgery, 170 (29.3%) were aged 80 and older. Multivariate logistic regression analysis revealed that age, presence of atrial fibrillation and coronary artery disease were independent predictors of perioperative complications in octogenarians undergoing hip fracture surgery.

Octogenarians represent nearly one-third of the patients with hip fracture in the real-world practice. Increased age, coronary artery disease and atrial fibrillation predict perioperative adverse events in patients undergoing hip fracture surgery.

The risk of femoral neck fracture increases in the End Stage Renal Disease (ESRD) patients who underge hemodialysis. The aim of this study was to describe our experience with the treatment of femoral neck fracture in this particular group of patients.

In a retrospective study, between January 2010 to December 2015, there were 16 displaced femoral neck fracture in 12 haemodialytic ESRD patient. All patients underwent total hip arthroplasty via direct anterior approach (three cementless and 9 cemented). No closed suction drain was used. Follow up regime was at 3,6 and 12 month and annually thereafter.

All patients were satisfied with the results of total hip arthroplasty. At the time of the final follow-up of 22 months (2-47) months, all the hips in the 12 haemodialytic patients functioned well without any loosening, and with a Harris hip score (HHS) of 90(82–100). Of those patients who received cementless components: one patient showed loosening of femoral component on the right and then left hip one year after surgery. He underwent revision of femoral component to a cemented one. The other complications include one greater trochanteric fracture, one intraoperative distal femoral fracture, one postoperative hematoma formation and one superficial surgical site infection.

In this small series, relatively high complication rate is observable in cases of ESRD with femoral neck fracture treated by hip Arthroplasty. The use of cemented femoral sterns is preferred and extra caution is advised to avoid fracture in such osteoporotic bones.

According to the literature, cardiovascular diseases are highly prevalent globally, while there is an increased risk of cardiovascular-related death in osteoarthritic patients. Therefore, the present study intended to investigate the cardiovascular risk factor prevalence in osteoarthritic patients.

This cross-sectional, descriptive study was performed at the orthopedics clinics of the Guilan University of Medical Sciences in 2017. The inclusion criteria were the 40-75-year-old patients who were selected using the convenience sampling method. They were diagnosed with osteoarthritis, and gave informed consent for participation. The study data included demographics, cardiovascular risk factors, medical history, and anthropometric measurements. After a qualitative analysis, the data were analyzed using the SPSS software version 16.

A total of 100 patients with knee osteoarthritis, including 79 female and 21 male patients with the mean age of 53.9±11.9 years, were included in the study. The prevalence of diabetes, hypertension, obesity, metabolic syndrome, and smoking in the participants was 31%, 33%, 45%, 51%, and 9%, respectively. 12% reported a history of previous heart attacks. Moreover, the prevalence of diabetes, obesity, hypertension, and metabolic syndrome was higher in women than men. Also, the mean age of the male patients was significantly higher than women (P = 0.03).

Given the high prevalence of cardiovascular risk factors in osteoarthritis patients, it is essential to notice the early cardiovascular disease detection in patients with knee osteoarthritis, especially in female patients.

The most common cause of knee pain is knee osteoarthritis, many surgical and non-surgical treatments have been proposed but the preferred treatment remains unknown. One of the non-surgical treatments was PRP (plasma reach platate) injection in these patients. Various studies have shown the improvement of the effect of PRP injection with substances such as calcium gluconate, so the aim of this study was to evaluate the effectof PRP with and without calcium gluconate on the clinical results of intra-articular injection of this substance in patients with knee osteoarthritis.

This was a cohort study in which patients were divided into two groups: PRP injection and PRP injection with calcium gluconate. The results of the study were evaluated by KOOS questionnaire and pain by VAS. A significance level of 0.05 was considered.

Generally, during the study, the pain level in patients after receiving both treatments significantly decreased during the six-month period, while the pain in the case group significantly decreased. (P Value <0.05).

From the results of this study, it can be concluded that simultaneous injection of PRP and calcium gluconate can further improve the results of injection.